The relation between coagulation, fibrinolysis and factor XIII levels in ulcerative colitis

Abstract

Background: Decreased factor XIII (F XIII) levels, the fibrinstabilizing clotting factor, has been described in ulcerative colitis (UC). Consumption of F XIII due to activation of coagulation or fibrinolysis, slow (re)generation of F XIII and gut leakage may account for this decrease. Addition of FXIII may be beneficial in the course of severe UC. We performed laboratory tests concerning coagulation and fibrinolysis in the course of UC to assess their relation with F XIII levels. Methods: A cohort of 20 patients with severe UC was prospectively followed for 12 weeks. At intervals (t=0,2,4,8,12 weeks), symptoms were assessed by a patient score (NEJM 1994, 1841) and blood samples were collected. Endoscopy was performed at baseline and at 12 weeks during which a disease activity score was calculated (J Clin Gastroenterol 1988, 169). This endoscopic score and laboratory findings were related to the patient score (PS) by application of Spearman rank correlation test. All patients were treated with 5-ASA and immunosuppressive therapy. Results: PS strongly correlated with the endoscopic score (r=0.68). A high PS, related with disease activity, was associated with decreasing levels of F XIII (r = -0.37), and increasing CRP (r = 0.52), fibrinogen (r = 0.44), TAT (r = 0.24), and fibrin degradation products (r = 0.30). Plasmin-dependent generation of fibrinogen degradation products was not associated with disease activity (r = -0.09). Low levels of F XIII were strongly associated with TAT (r = -0.65), and CRP (r = 0.52), but not with fibrinogen degradation products (r = -0.09). Conclusions: Activation of coagulation in active UC was demonstrated by positive correlations of PS with TAT and fibrin degradation products. F XIII was strongly correlated with parameters of coagulation, but not with fibrinolysis. We hypothesize that F XIII decrease is due to consumption.